Background
Data evaluating the use of glucagon-like peptide receptor agonists (GLP-1 RA) in people with HIV (PWH) is limited, particularly with tirzepatide, a GLP/GIP dual agonist, given its more recent approval date. We aim to describe real world metabolic outcomes in PWH using tirzepatide for weight loss or diabetes treatment.
Methods
Included were PWH seen at the UCSD Owen clinic and prescribed tirzepatide between May 2022 and December 2024 to allow for a minimum of 6 months of follow up, with the start and end date of tirzepatide use determined using prescription records. Patients were excluded if they received a prior GLP-1 RA. Baseline demographics, HIV related data including antiretroviral (ARV) regimens, as well as the presence of various comorbidities were collected. Patient weights were assessed at quarterly intervals out to 12 months after initiating tirzepatide and reasons for discontinuation prior to 12 months were captured. Quarterly changes in hemoglobin A1C and blood pressure (BP) as well as 12-month cholesterol panel values were collected if available.
Results
A total of 61 patients were included in the study with baseline demographics and HIV related variables found in Table 1. The majority of patients (62.3%) were receiving an ARV regimen containing both a second-generation integrase strand transfer inhibitor and tenofovir alafenamide. 15 patients (24.5%) discontinued tirzepatide prior to 12 months due to side effects (6), supply or insurance challenges (8), or lack of efficacy (1). For those with weight data available at 3 (n=52), 6 (n=45), 9 (n=36), and 12 (n=34) months the mean change in weight was -7.2kg, -12.2kg, -12.9kg, and -15.4kg respectively and was statistically significant at each time point. Of the 22 participants with diabetes (36.1%), the mean baseline A1C was 7.6% and of those with paired A1C data at 6 months (n=12), mean A1C decreased from 8% to 5.9%. Systolic BP decreased from a mean of 130.2mmHg at baseline to 120.5mmHg at 6 months in those with available data (n=47), p<0.001, and 26.7% (8/30) of those taking blood pressure medication at baseline were able to reduce the number of medications they were taking.
Conclusions
The use of tirzepatide in PWH resulted in significant reductions in weight as well as improvement in A1C and blood pressure control, however a quarter of patients discontinued treatment prior to one year, primarily due to insurance or supply related challenges.
Table or Figure
